Trends in the use of the Internet for health purposes in Poland

Assessing the e-health literacy level and its predictors in heart patients: A Case Study in a Heart Hospital Center in Iran

BACKGROUND

eHealth literacy has many benefits for patients and community members, including the direct impact on improving the quality of patient education and reducing direct and indirect healthcare costs. Benefiting from eHealth literacy in patients with cardiovascular diseases can effectively provide healthcare services and manage these patients. This study aimed to evaluate eHealth literacy level and its factors affecting patients with cardiovascular diseases in a Heart Center Hospital.

MATERIALS AND METHODS

This cross-sectional study was conducted in 2022. A valid and reliable questionnaire has been used for data gathering. From 147 distributed questionnaires among patients with cardiovascular diseases at Madani Heart Center Hospital in Khorramabad city, finally, 86 questionnaires have been collected completely. Data analyses were done using IBM Statistical Package for the Social Sciences (SPSS) software version 22 descriptive and analytical tests such as one-way ANOVA, independent sample t-test, and Spearman correlation coefficient based on the study objectives.

RESULTS

The study showed that heart patients' eHealth literacy status is moderate (3.38 out of 5). The awareness of the availability of resources on the Internet had the highest score (3.79). The importance of using the Internet to obtain health information (r = 0.62, P < 0.001) and the ability to use the Internet (r = 0.62, P < 0.001) had the most significant relationship with eHealth literacy among patients with cardiovascular diseases.

CONCLUSION

It is suggested that by increasing the level of Internet skills, expanding the use of the Internet for health-related services, using the Internet to make accurate health decisions among patients, extending the use of the Internet to access health resources, and reducing the patient's level of concern about their health status to improve the level of eHealth literacy of cardiovascular patients.

Assessment of the reliability and quality of breast cancer related videos on TikTok and Bilibili: cross-sectional study in China

Background

As the most common malignant tumor in the world, breast cancer also brings a huge disease burden to China. Ordinary people are increasingly inclined to use the Internet, especially video social platforms, as a source of health information. Educating the public to obtain correct information is important to reduce the incidence of breast cancer and improve the prognosis. However, the quality and reliability of breast cancer-related video content have not been fully studied.

Objective

This study aims to evaluate the quality of the information of breast cancer-related videos on TikTok and Bilibili video sharing platforms and factors related to video quality.

Methods

We collected the top 100 videos about breast cancer on TikTok and Bilibili, respectively. Categorize videos according to video source and video content. Video quality and reliability were assessed using Global Quality Score (GQS) and modified DISCERN (mDISCERN) tools. We also analyzed the correlation between video quality and video likes, comments, saves, and shares.

Results

Although the quality and reliability of Bilibili's breast cancer videos were higher than TikTok (p = 0.002 and p = 0.001, respectively), the video quality of both video sharing platforms was not satisfactory, with a median GQS scores of 2.00 and 3.00 and mDISCERN scores of 1.00 and 2.00, respectively. In general, the quality and reliability of videos released by medical practitioners were higher than those of non-medical practitioners, and the quality and reliability of videos covering disease-related knowledge were higher than those of news reports (all p < 0.001). Among medical practitioners, the quality of videos uploaded by doctors in breast disease was significantly lower than that of doctors in other areas (p < 0.05). There was a significant positive correlation between video quality and duration (r = 0.240, p < 0.001), a weak negative correlation between video quality and likes (r = 0.191, p < 0.01), video quality and comments (r = 0.256, p < 0.001), video reliability and likes (r = 0.198, p < 0.001), video reliability and comments (r = 0.243, p < 0.01).

Conclusion

Our study shows that the quality and reliability of breast cancer-related videos on TikTok and Bilibili are poor, and the overall quality is unsatisfactory. But videos uploaded by medical practitioners covering disease knowledge, prevention and treatment are of higher quality. Medical practitioners are encouraged to publish more high-quality videos, while video social platforms should formulate relevant policies to censor and supervise health education videos, so as to enable the public to obtain reliable health information.

The significance of information variables in polydrug use by adolescents: insights from a cross-sectional study in Tarragona (Spain)

Substance use, especially among adolescents, is a significant public health concern, with profound implications for physical and psychological development. This study aimed to evaluate the quantity and sources of information available to adolescents regarding polydrug use. A cross-sectional survey was conducted in Tarragona involving adolescents with an average age of 16.44 years. This study assessed the number of substances used (alcohol, cigarettes, and cannabis) in the past month, along with information sources related to substance use. Monitored sources (e.g., schools, parents, and mass media) and unmonitored sources (e.g., peers, siblings, internet) were distinguished. In addition, four individual and four environmental control variables were considered. Multinomial logistic regression analysis revealed that incorporating variables related to adolescents' substance use information and its sources enhanced the explanatory model, surpassing control variables. The degree of information about substance use did not significantly explain consumption patterns, but the number of information sources, both monitored and unmonitored, did. The unmonitored sources were associated with increased polydrug use. Conversely, greater reliance on supervised sources for information was linked to reduced single-substance and polydrug use. This protective effect increased with an increase in the number of substances used. In conclusion, information obtained from monitored sources acts as a deterrent to substance consumption, consistent with findings suggesting that greater health literacy among adolescents discourages substance use. Conversely, this study suggests that information from more informal sources may encourage heavier polydrug use, aligning with reports indicating that adolescents with a more comprehensive understanding of substance use consequences tend to engage in heavier drug use.

Factors associated with delayed first ophthalmological consultation for primary glaucoma: a qualitative interview study

Background

Glaucoma has an insidious onset with non-specific early symptoms, often leading patients to delay in seeking help. However, postponing the first ophthalmological consultation can result in delayed diagnosis and treatment, with adverse effects on vision. This study explored the factors associated with delayed first ophthalmological consultation in patients with primary glaucoma, with the overarching aim of informing measures to reduce delayed consultation and avoid the consequent adverse outcomes.

Methods

We adopted a phenomenological approach. Semi-structured interviews were conducted with patients admitted to a tertiary eye hospital in Tianjin, China, from January 2021 to April 2021. Data were analyzed by Colaizzi's seven-step method.

Results

We identified 46 patients with primary glaucoma who delayed their first ophthalmological consultation for various reasons. There were four major themes and 16 sub-themes. The major themes were as follows: (1) occult symptoms that are difficult to identify; (2) insufficient knowledge and understanding of glaucoma-related risks and harm; (3) perceived difficulties in accessing medical care; and (4) inadequate support system.

Conclusion

In order to avoid patient delay and consequent irreversible damage to the visual field in patients with primary glaucoma, it is essential that medical staff identify symptoms more effectively, change habitual medical behavior of the patients, adopt a medical union model, and promote the use of a social medical support system to address practical difficulties in delivering adequate care.

Internet Use and the Happiness of Rural Residents: The Role of Education and Health

The rapid development of the Internet in China in recent years has greatly penetrated into all aspects of people's lives and production. In rural areas of China, little is known from previous studies about the relationship between the Internet and happiness. Based on data from the China Family Panel Studies (CFPS) collected in 2016 and 2018, this study investigates the impact of the Internet use on the happiness of rural residents and its mechanism. The results show that, first, the fixed-effects model indicates that the Internet significantly increases the happiness of rural residents. Second, the multiple mediating effects analysis shows that Internet use can improve rural residents' happiness by promoting the household education human capital. To be more specific, excessive Internet use leads to lower levels of household health human capital. However, a lower level of health does not necessarily bring about a lower level of happiness. In this paper, the mediating effects of household education human capital and household health human capital are 17.8% and 9.5%, respectively. Third, the heterogeneity analysis found that there was a significant positive correlation between Internet use and rural residents' happiness in western regions of China, while it is insignificant in the eastern and central regions; for households with a huge labor force, Internet use dramatically improves their happiness by enhancing their household education human capital. Education and health have different roles to play in terms of the happiness of rural residents. Therefore, this suggests that the physical and psychological health of rural residents should be taken into account when the Internet strategies to improve general well-being are under development.

The potential of eHealth for cancer patients-does COVID-19 pandemic change the attitude towards use of telemedicine services?

BACKGROUND

Internet penetration worldwide has increased rapidly over the recent years. With this growth, modern information and communication technologies (ICT) have become increasingly important. They do not only change daily life but also patient-physician interaction and health related information search, which can be summarized as electronic Health (eHealth). eHealth was already known before the emergence of the coronavirus disease 2019 (COVID-19), but this pandemic substantially challenged health systems, physicians and hospitals so profoundly that new services and methods of patient-physician interaction had to be implemented rapidly. This study investigates the attitude of cancer patients towards eHealth and the potential impact of COVID-19 on its use.

METHODS AND FINDINGS

The study was a multicentered study carried out at the university hospitals Bonn and Aachen. Patients were asked to answer a structured questionnaire in the time span between September 2019 and February 2021. Due to the COVID-19 pandemic, no patients were addressed between March 2020 and July 2020. The questionnaire focused on socio-demographic data, the dissemination of internet-enabled devices, the patients' attitude towards eHealth and the use of modern ICT in daily life and for health-related information search. In total, 280 patients have filled the questionnaire of which 48% were female and 52% were male. Men have a slightly more positive attitude towards the overall potential of eHealth than women which was shown by a significant influence for receiving medical information via e-mail. Hematological-oncological patients with a higher education level reported a significantly higher willingness to send personal health information to their physician and health insurance. A frequency of medical consultation of more than 5 times during the previous year has a significantly positive impact regarding the use of online communication, online video consultation and treatment quality. Younger patients have more concerns about data security than older patients. The study shows a different attitude towards the influence of eHealth on the patient-physician relationship in different therapy situations. While there were no significant changes in patients' attitude towards eHealth after the start of the COVID-19 pandemic, there was a trend towards an increasingly embracing attitude in patients, who answered the questionnaire during COVID-19 pandemic situation.

CONCLUSIONS

Overall, cancer patients had a positive attitude towards eHealth and the dissemination of internet-enabled devices was high. The study shows that the potential of eHealth is high among hematological-oncological patients. Further eHealth technologies and especially telemedically supported care processes should be implemented to improve patient-physician interaction and cross-sectoral care. COVID-19 pandemic led to a fast initiation and acceleration of new structures and routines for physicians, hospitals and patients. These new processes should be used to promote digitalization in hematological and oncological telemedicine. To successfully implement new eHealth technologies, future research should focus on patients' concerns about data privacy and data availability especially in the context of exchange of medical information in cross sectoral and interdisciplinary care processes.

Evaluation of quality of diabetic foot examination on YouTube

INTRODUCTION

Foot ulcers and amputations are common conditions in people with diabetes and can considerably impact quality of life, necessitate a lengthy hospital stay and increase mortality. Preventative foot care and examination can prevent or delay ulceration, and individuals may seek information from publicly available social media resources such as YouTube. Therefore, the purpose of this study is to evaluate the educational quality and reliability of publicly available YouTube videos on diabetes foot examinations.

METHOD

A YouTube search for "diabetic foot examination" was conducted, and the first 100 relevant English videos focused on examining the diabetic foot were included for evaluation. The Journal of the American Medical Association (JAMA) standards were used to measure video reliability. The Global Quality Score (GQS) and the Diabetes UK Annual Foot Check (DUK-C) checklist were used to assess video educational quality. Differences in JAMA, GQS, and DUK-C ratings were analysed after videos were sorted by topic and source.

RESULTS

The mean number of views per video was 101,311.9 ± 348,383.6, and the mean video power index was 41.6 ± 170.0. The most common upload source was from physicians (28%) and, the most popular material category was diabetes foot examination (58 videos). In terms of video reliability, 36% of videos scored 0. According to the GQS standards, only 5% of the videos are of excellent quality, while 34% are of poor quality, with 24 videos scoring between 0 and 1 on the DUK-C scale.

CONCLUSION

While foot care examination videos have a substantial audience, the majority are considered low in quality and reliability. Videos on comprehensive diabetic foot examination should be accessed on reputable sources that guarantee standardisations of video quality and take into account the simplification of information transmission in order to reach lay audiences.

Digitalization and Urological Diseases: Severity of Cyberchondria and Level of Health Anxiety in Patients Visiting Outpatient Urology Clinics

This study aimed to evaluate the cyberchondria levels of patients who applied to the urology outpatient clinic. The second goal of this study was to evaluate the relationship between cyberchondria severity and health anxiety in these patients. The present prospective observational study was conducted at the urology outpatient clinic of two tertiary centers in our city between September and December 2021. Eligible patients were the adult patients (>18 and ≤60 years) who used the Internet for health purposes and had no self-reported psychological or mental disease. The patients were divided into following groups according to their complaints: general urology, uro-oncology, andrology, functional urology, and endourology (stone disease). The level of cyberchondria and health anxiety was evaluated for these patients by using the Short Health Anxiety Inventory (SHAI) and a short-form version of the Cyberchondria Severity Scale (CSS-12). This study enrolled 578 patients (190 female, 388 male). The mean age of patients was 43.4 ± 13.3 years (18-60 years). The mean CSS-12 was 28.1 ± 12.1, and the mean value of SHAI was 18.9 ± 13.6. The patients had andrological symptoms, is uniquely related to higher CSS and health anxiety, and followed by uro-oncological diseases. However, the least relationship was observed in patients with functional urological diseases (analysis of variance [ANOVA], p < 0.001 for CSS-12; p < 0.001 for SHAI). In addition, a positive correlation was observed between the CSS and SHAI (Pearson's correlation = 0.782). The increased level of cyberchondria causes increased health anxiety and an increased disease burden in these patients. Therefore, physicians should consider this increased treatment burden during the treatment of patients.

Burden of Neurological Diseases in the Philippines as Revealed by Web Searches: An Infodemiological Study

Due to the real-time acquisition of big data from the Internet, analysis of Google queries is now recognized as a valuable tool to explore and predict human behavior and interests. It was suggested that online data can be correlated with actual health data. Although the data are not structured nor systematic, the huge data from search engines can easily identify trends concerning diseases and other health concepts from a population perspective. Moreover, Internet data with the use of web search advertising nowadays may not only reveal the interest of the general population but also of the healthcare industry as reflected by the bid prices in search terms for medications. We aimed to compare the interests of the general population using monthly search volumes from Google and the healthcare industry using bid prices in web searches. Data used in this study were obtained from the Google Ads Application Programming Interface (API). This study evaluated the population's interest in neurological disorders by using search volumes related to neurology, either disease diagnosis or medications. Bid values generated in API were used as a proxy for the interests of the healthcare industry. Spearman's rank-order correlation was performed between search volumes and bid prices to determine significance. Among the neurologic diseases listed, the most searched were attention deficit hyperactivity disorder, migraine, and Alzheimer's disease. The most commonly searched drugs were oral antihypertensives (amlodipine, losartan, carvedilol), lipid-lowering agents (atorvastatin, simvastatin, rosuvastatin), and antiplatelets (acetylsalicylic acid, clopidogrel). The other most searched drugs were analgesics such as acetaminophen, tramadol, diclofenac, and morphine. The correlational analysis did not reveal a statistically significant correlation between search volume and bid price for both neurologic diseases and medications. Web searches may reflect the interest of the general population and the healthcare industry. However, there was disagreement in the search interests of the general population and the scientific community, including the pharmaceutical industry. Further studies are necessary in order to align these interests for the common benefit of all stakeholders.

Use of the Internet for Health Purposes-A National Web-Based Cross-Sectional Survey among Adults in Poland

The Internet is one of the most popular information sources. This study aimed to assess the public attitudes towards the use of the Internet for health purposes as well as to identify factors associated with the use of the Internet for health purposes among adults in Poland. A web-based cross-sectional survey was carried out between 9 and 12 September 2022 on a nationwide random-quota sample of 1092 adults in Poland. The study questionnaire included 10 questions on Internet use for health purposes. The most common reason for the use of the Internet for health purposes was searching for information on drugs and their effects (69.9%). Almost two-thirds of participants used the Internet for searching for health information (64.9%), for doctors/medical services (63.4%), or for medical facilities (65.3%). Over half of the participants used the Internet for checking online reviews of doctors (55.2%) and 43.5% of the participants ordered drugs or dietary supplements online. Out of 9 different socioeconomic factors analyzed in this study, having higher education, being female, as well as living in cities from 100,000 to 499,999 residents were the most important factors (p < 0.05) associated with the use of the Internet for health purposes. This study confirmed a high level of adoption of medical Internet in Poland.

Social Media as a Source of Knowledge about Gene Therapy for Spinal Muscular Atrophy

Social media is one of the most common sources of medical information. We aimed to evaluate the information contained on websites, including social media and descriptions of fundraisers, in terms of the reliability of knowledge about SMA and gene therapy with onasemnogen abeparvovec. We used a set of available online links found using the Newspointtool. Initially, 1525 texts were included in the study, and after applying the inclusion and exclusion criteria, 112 texts were qualified for analysis using the DISCERN scale and the set of questions prepared by the authors. We observed that most of the texts had poor (48.65%) and medium (27.03%) reliability in the final reliability assessment. All the texts selected for the study were related to gene therapy, although few contained key information about it. In addition, the authors of the entries used various words and phrases that influenced the readers' perceptions of the text. Of the analyzed sources, 68.8% had an emotional component. Social media is a poor source of information about gene therapy for SMA in Poland. The analyzed texts do not provide a full and complete description of the SMA problem. However, it is important to remember that the Internet is a changing source of information and will hopefully contain more relevant entries in the future.

The Relationship between Searches for COVID-19 Vaccines and Dynamics of Vaccinated People in Poland: An Infodemiological Study

BACKGROUND

Google Trends has turned out to be an appropriate tool for evaluating correlations and prognostic modelling regarding infectious diseases. The possibility of selecting a vaccine against COVID-19 has increased social interest in particular vaccines. The objective of this study was to show dependencies between the frequency of searches for COVID-19 vaccinations and the number of vaccinated people in Poland, along with epidemiological data.

METHODS

Data were collected regarding Google searches for COVID-19 vaccines, the number of people in Poland vaccinated against COVID-19, the number of new cases, and the number of deaths due to COVID-19. Data were filtered from 27 December 2020 to 1 September 2021.

RESULTS

The number of new vaccinations smoothed per million correlated most strongly with searches for the word 'Pfizer' in Google Trends (Kendall's tau = 0.46, p < 0.001). The number of new deaths correlated most strongly with the search phrase 'AstraZeneca' (Kendall's tau = 0.46, p < 0.001). The number of new cases per million correlated most strongly with searches for 'AstraZeneca' (Kendall's tau = 0.49, p < 0.001). The maximum daily number of searches ranged between 110 and 130. A significant interest in COVID-19 vaccines was observed from February to June 2021, i.e., in the period of a considerable increase in the number of new cases and new deaths due to COVID-19.

CONCLUSIONS

A significant increase in interest in COVID-19 vaccines was observed from February to June 2021, i.e., in the period of gradually extended access to vaccinations, as well as a considerable increase in the number of new cases and new deaths due to COVID-19. The use of Google Trends with relevant keywords and a comparison with the course of the COVID-19 pandemic facilitates evaluation of the relationship between the frequency and types of searches for COVID-19 vaccines and epidemiological data.

The Impact of Internet Use on the Happiness of Chinese Civil Servants: A Mediation Analysis Based on Self-Rated Health

With the rapid socioeconomic development of China, studies related to Internet use and civil servants' happiness have become a research hotspot in Chinese academia. This study empirically analysed the impact of Internet use on the happiness of Chinese civil servants using a sample of 3793 civil servants in Hunan Province, China. It showed that Internet use significantly enhanced the subjective well-being of Chinese civil servants. Furthermore, heterogeneity analysis revealed significant heterogeneity in the effect of the Internet on civil servants' happiness, which varied across civil service groups with different education and gender. Moreover, the effect of Internet use on the happiness of the male and better educated civil servant groups was more pronounced than in the female and less educated civil servant groups. Additionally, mediation analysis revealed that Internet use and the happiness of civil servants were not linear, with health having a significant mediating effect. This indicates that Internet use helps civil servants maintain good health, and thereby enhances the happiness of civil servants. In addition, we also use a propensity score matching model (PSM) to address the endogeneity problem due to sample selectivity bias. The results show that the estimates are more robust after eliminating sample selectivity bias. The effect of Internet use on civil servants' subjective well-being would be underestimated if the sample selectivity bias is not removed.

Knowledge and Awareness of Polish Parents on Vaccination against Human Papillomavirus

Background: Human papillomavirus (HPV) vaccinations are rare among Polish children, and the reasons are scant. The objective was to evaluate the knowledge, attitude and awareness of parents about HPV vaccination to investigate reasons for low HPV vaccination coverage. Methods: 387 parents of children hospitalized at the Children’s Hospital were asked to participate in an anonymous and voluntary survey study. Three hundred and two surveys were returned. Results: Only 54% of participants have heard about HPV, while 26% know that it is a sexually transmitted disease. According to 71% of responders, vaccines are generally effective, and 63% claim that they are safe. However, only 5% of daughters and 4% of sons are vaccinated against HPV. A total of 25% of parents spoke with their doctor about HPV-related diseases and prevention methods. A higher level of education (p = 0.01), knowledge of sexually transmitted diseases (p < 0.0001), perceiving vaccination as an effective and safe prophylactic method (p < 0.0001), and conversations with a doctor (p < 0.0001) are strong motivators to vaccinate children against HPV. This decision is free of religious beliefs, origin, age, gender and the number of children. Conclusions: Polish parents have a positive attitude towards vaccination. They recognize the limitations of their knowledge and express a desire to further it. Educational activity is an important element of physicians’ work.

Influence of Certain Social Aspects on Most Likely Internet Usage Scenarios

This paper aims to analyze the influence that certain social factors (education and area of residence) have on the most likely scenarios people encounter in their online activities. Among the possible scenarios of using the internet, based on everyday individuals’ activities, we selected seeking information about health, goods, and services, taking online courses, internet banking, and participating in social networks. Using data acquired from international databases over the 2002–2020 period, we proposed five hypotheses and applied a multilinear regression model to the data collected for four European countries, namely, Bulgaria, Greece, Romania, and Slovenia. We have analyzed the degree of confirmation for all five hypotheses. The results provided a better understanding of the influence of the above-mentioned factors on the considered scenarios, allowing stakeholders to define and propose specific development policies.

How to Educate the Public about Dental Trauma-A Scoping Review

Educating the general population about dental trauma is of public health interest. The aim of this scoping review was to map research on traumatic dental injuries (TDIs) education in the general population and to identify the most relevant methods of knowledge transfer. PubMed, Scopus, Web of Science All Databases, reference lists, and grey literature were searched. Articles in English published between 2000 and 2020 were included. A total of 32 articles fulfilled inclusion criteria. The most frequently tested modality was lecture/seminar/workshop. Studies focused mainly on teachers and medical staff as target groups. Post-intervention evaluation showed an increase in knowledge. In long-term follow-up, a decrease in knowledge was found. The effectiveness of different modalities varied. Studies comparing single-modal and multimodal approaches did not confirm the effect of combined methods. Printed materials are a practical mode for laypeople. Lectures should be reserved for professions with high probability of coming into contact with a TDI victim. The Internet can be a promising tool to educate people. Educators have to choose the method of communication most appropriate for the target population. The education should include topics related to dental trauma prevention. Further research is needed to investigate the effectiveness of multimodal TDI education.

Inequity in the Access to eHealth and Its Decomposition Case of Poland

The aim of this research is to analyze the disparities in the distribution of information and communication technologies and skills across geographically determined population groups and to identify the source of the inequity. Literature showed that the nature of e-Health has the potential to resolve health inequalities. However, its successful implementation depends on such factors as the accessibility of required technologies to all people, the existence of technical infrastructure as well as people having the necessary information and communication skills. Employment of the Theil index allowed us to measure and decompose the national inequality into both: between and within macro-regions differences. Data was collected from Statistics Poland. The results showed the existence of inequity and its drivers. The novelty of this research results from application of the Theil index in the field of eHealth and identification of the barrier in access to e-Health, which can be a basis for improvement in government policy.

Older adults’ mental health information preferences: a call for more balanced information to empower older adults’ mental health help-seeking

A small minority of older adults seek psychological help when they need it. Barriers to mental health service use among older adults include low mental health literacy and reduced opportunities for shared decision-making in health care. There is a gap in the literature examining the mental health information preferences of older adults. The objectives of this study were to describe the information preferences and predictors of preferences among older adults. In total, 229 adults aged 50 years and older in central Canada responded to a questionnaire investigating socio-demographic, psycho-social and health-related characteristics, as well as mental health information preferences. Descriptive analysis quantified participants’ ratings of information preferences and hierarchical linear regression analysis determined predictors of their preferences. Older adults rated all mental health content items as very important. Most participants preferred detailed information (two to six pages) on all treatment options (psychological, pharmacological, combined and self-help). Older adults significantly preferred discussion with a heath-care provider and written information, in comparison to other formats. Older adults also significantly preferred to consult family, friends and heath-care professionals over other sources. Socio-demographic and psycho-social characteristics accounted for some of the variance in predicting older adults’ information preferences. Findings highlight older adults’ desire to be involved in decisions concerning mental health supports. Providing balanced information concerning mental health treatment may increase empowerment in mental health help-seeking.

IS THERE AN ASSOCIATION BETWEEN HEALTH LITERACY AND ADHERENCE TO THE MEDITERRANEAN DIET? A CROSS-SECTIONAL STUDY IN GREECE

OBJECTIVE

The aim: To evaluate the relationship between adherence to the Mediterranean diet and health literacy and to find possible differences based on the demographic characteristics of the participants.

PATIENTS AND METHODS

Materials and methods: A cross-sectional study was carried out with a convenience sample from the Greek general population (n=203). The questionnaires were distributed through the Google Forms platform, while some of them were given on hand. The questionnaire used included demographic information, questions about the participants' health status and nutrition habits and the Health Literacy Scale (HLS - EU-Q16) and the MedDietScore. The survey was conducted June - July 2022. The program SPSS v. 26.0 was used for the analysis of data.

RESULTS

Results: The mean score in HLS-EU-Q16 was 12.08 (SD=4.17) (15.8%=inadequate level, 30% =problematic level, 54.2%=sufficient level). The mean score in Med DietScore was 31.54 (SD=4.84) and the majority (72.4%) had medium adherence to the Mediterranean diet. Concerning the HLS-EU-Q16, women and those who had not children, were not patients and used the Internet for finding health information had higher score. In contrast, widows/ers and those with elementary education had lower score. With regard to the Med DietScore, those who were patients and had normal weight had higher score than the rest categories. A negative correlation was found between age-HLS-EU-Q16 (r=-.605, p<.01) and between BMI-Med DietScore (r=-.142, p<.05).

CONCLUSION

Conclusions: Most of the participants had sufficient level of health literacy and medium adherence to the Mediterranean diet. Furthermore, there was not a significant correlation between adherence to the Mediterranean diet and health literacy. Several demographic and medical characteristics impact the health literature level and the adherence to the Mediterranean diet. Future research is suggested to further evaluate the results of this study.

The Use of Internet and Social Media for Health Information and Its Consequences Among the Population in Saudi Arabia

Background: The Internet is being increasingly used in our lives. Along with Internet use, social media sites are especially popular and are used by many people on a daily basis. Many studies were conducted to see the people’s perception and their attitude towards the use of the Internet for health information. Such studies were also carried out in Saudi Arabia, but most have been limited to a specific target sample of the population. Our study aimed to assess the perception towards and use of different platforms and search engines to seek health information in Saudi Arabia.

Method: A cross‐sectional study was conducted in Saudi Arabia during the year 2021. An Arabic online questionnaire using Google forms was sent to a randomized sample. Microsoft Excel 2016 was used for data entry, and statistical analysis was performed using IBM© SPSS© Statistics version 25 (IBM© Corp., Armonk, NY, USA).

Result: Among the 1363 participants, 56.2% were females and 43.8% were males with a mean age of 30.73 ± 12.3. The majority were living in Western region. The most used social media platforms were WhatsApp (91.5%), YouTube (84.6%), and Twitter (82.6%), respectively. The most common medical websites browsed were the Saudi Ministry of Health (67%) and the Food and Drug Administration (54.4%). Some 40.1% of the participants had a medical consultation online from a doctor, and most of them (67.8%) trusted the online physician. Finally, most of the participants (90.9%) thought that health information on the Internet or social media contributes to raising the level of health awareness among the general population. There was a significant relationship between educational level and gender and online health-seeking behavior (p > 0.05).

Conclusion: The study reinforced that health information that is sought from the Internet and social media platforms has a great impact on the population, emphasizing the need for credible information sources and how to access them.

Users evaluation of a Spanish eHealth pediatric website

BACKGROUND

Parents use the Internet to take decisions about their children's health, but few resources have focused on eHealth technology evaluations from their point of view.

OBJECTIVE

The main aim of this research was to evaluate a Spanish eHealth pediatric website for parents.

METHODS

A previously validated web questionnaire was used to evaluate five domains: usability, utility, trust and confidence, well-child section and accessibility of the website. Univariate, bivariate and multiple linear regression analyses were performed.

RESULTS

516 users participated in the research and rated the website as usable, useful, trustworthy and accessible. Higher scores were given by the participants who relied most on the Internet for taking decisions about health; by the participants who used a smartphone to access the pediatric website; by the participants who knew the website the longest; and by the participants who had accessed it more times. No differences in the evaluations of the website were found regarding age, education level or household income of the participants.

CONCLUSIONS

eHealth pediatric websites, written by a pediatrician in an easy to understand language, can be perceived as usable, trustworthy, useful and accessible by their users and consequently help them with their decisions making. Some characteristics of the users are associated with a better perception of these websites.

Profile of the Users and the Most Visited Topics of a Pediatric eHealth Website

Parents need information about their children's health, and the Internet has become an essential repository for this information. However, there is almost no information about which topics are the most searched, consulted, or shared, or about the main characteristics of pediatric website users. The main aim of this research was to describe the profile of the users of a pediatric website, which topics they searched for, which topics were the most consulted, and which were the most shared. Users' demographic data were analyzed regarding their use of the Internet to search for information about health. A pediatric website for parents was analyzed. A 26-item questionnaire collected demographical features of the users of the website. Descriptive and analytical analyses were performed. Most participants used general search engines for their health searches, and the most searched keywords were prurigo, barking cough, and laryngitis. The most visited topics were unexplained fever, snots, and laryngitis. The most shared were snots, lipotomy, and dizziness. The users were mainly women (67.8%), with an average age of 38.8 years, and one or two children (89%) with a mean age of 4.6 years. The users who mainly used the Internet for health purposes were women of younger age, and with a higher educational level.

YouTube videos as a source of information concerning Behçet's disease: a reliability and quality analysis

In this study, we aimed to investigate the reliability and quality of YouTube videos concerning Behçet disease, for the first time in the literature. The most viewed 50 YouTube videos about Behçet disease were included. Study data used in the analysis included video length, image type, video content, uploaders, time since the date of upload, the number of total views, daily views, and the numbers of like, dislike and comments. The Video Power Index was used to determine popularity of the videos. Reliability and quality of the videos were evaluated using DISCERN and Global Quality Scale (GQS) instruments. The examined YouTube videos were divided into two groups as uploaded by professionals (physicians, health and hospital channels, institutions and societies) and non-professionals (patients, social organizations, others). Twenty-three (46%) videos were uploaded by professionals. The mean DISCERN score was found as 3.98 ± 0.77 in the videos uploaded by healthcare professionals and 2.83 ± 0.64 in those uploaded by non-professionals (p < 0.01). The mean GQS score was found as 4.09 ± 0.72 in the videos uploaded by healthcare professionals and 3.41 ± 0.69 in those uploaded by non-professionals (p < 0.01). 46% of the videos were of low-to-moderate reliability and 56% of low-to-moderate quality. Nearly half of the YouTube videos concerning Behçet disease were uploaded by non-physician sources with poor reliability and quality. Physicians should be encouraged to upload more professional videos to help and guide patients appropriately. YouTube videos should be subjected to an objective evaluation for content quality before they can be published.

The Internet: Friend or Foe of Antibiotic Resistance? Results of a Cross-Sectional Study among Italian University Students

The study aims were to investigate knowledge and attitudes towards antibiotics and antibiotic resistance (ABR), and to assess the extent of practices regarding antibiotic consumption and Internet use among university students in Southern Italy. Data were collected through an anonymous online questionnaire from 1 April to 14 April 2021. The eligibility criteria for the study were: (i) age between 18 and 30 years and (ii) registered as an undergraduate student at the university. Among the 1051 sampled students, only 7.4% gave the correct answer to all 7 knowledge statements about antibiotics and ABR. The main determinants of knowledge were being younger and attending to medical or life sciences majors. Almost two-thirds took an antibiotic in the previous 12 months and 24.6% reported having self-medicated with antibiotics. More than half of the sample used the Internet to seek information about antibiotics and/or ABR, and it was the strongest predictor of self-medication with antibiotics. The study findings highlighted gaps in knowledge, considerable antibiotic consumption, sometimes without prescription, together with an extensive Internet use to seek health-related information. To facilitate the health-promoting use of the Internet in conjunction with health care providers, we could make young adults aware of the rational use of antibiotics.

Characteristics of the Measurement Tools for Assessing Health Information-Seeking Behaviors in Nationally Representative Surveys: Systematic Review

BACKGROUND

The coronavirus pandemic (COVID-19) has also emerged as an infodemic, thereby worsening the harm of the pandemic. This situation has highlighted the need for a deeply rooted understanding of the health information-seeking behaviors (HISBs) of people.

OBJECTIVE

The aim of this paper was to review and provide insight regarding methodologies and the construct of content in HISB surveys by answering the following research question: what are the characteristics of the measurement tools for assessing HISBs in nationally representative surveys around the world?

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses was used as the framework for this study. A data search was performed through 5 international and 2 Korean databases covering the years between 2008 and 2020. Initially, studies performed among nationally representative samples were included to discover HISB survey instruments. The methodologies of the studies using HISB surveys were analyzed. For content analysis, 2 researchers reached a consensus through discussion by scrutinizing the contents of each survey questionnaire.

RESULTS

A total of 13 survey tools from 8 countries were identified after a review of 2333 records from the search results. Five survey tools (Health Information National Trends Survey, Health Tracking Survey, Annenberg National Health Communication Survey, National Health Interview Survey, and Health Tracking Household Survey) from the United States, 2 instruments from Germany, and 1 tool from each of the countries of the European Union, France, Israel, Poland, South Korea, and Taiwan were identified. Telephone or web-based surveys were commonly used targeting the adult population (≥15 years of age). From the content analysis, the domains of the survey items were categorized as follows: information (information about health and patient medical records), channel (offline and online), and health (overall health, lifestyle, and cancer). All categories encompassed behavioral and attitude dimensions. A theoretical framework, that is, an information-channel-health structure for HISBs was proposed.

CONCLUSIONS

The results of our study can contribute to the development and implementation of the survey tools for HISB with integrated questionnaire items. This will help in understanding HISB trends in national health care.

Experience and perspectives of users and non-users of the Ask your pharmacist teleconsultation platform

Background

There is a growing trend concerning the use of information and communication technologies (ICT) for seeking health-related information such as information on medications and side effects. However, people looking online for health information cannot always judge the credibility of the information.

Objective(s)

This study aimed to describe patients' and pharmacists' experience using an asynchronous teleconsultation platform entitled “Ask Your Pharmacist” (AYP) and gather their perspectives and those of various healthcare and social services professionals providing primary care.

Methods

We performed semi-structured individual interviews over the telephone with patients having used the platform, pharmacists providing teleconsultation services on the platform, and various professionals delivering healthcare and psychosocial services to ambulatory patients. The questions explored specific themes, such as the perceived utility and impacts of the platform. We transcribed the interviews and performed a content analysis.

Results

We interviewed eight patients, six AYP pharmacists, and 15 healthcare and social services professionals. Participants perceived that the platform was simple to use and accessible. They also perceived that AYP promoted the visibility and the value of pharmacists' services. Some constraints were also shared, notably regarding questions requiring immediate attention or about complex situations.

Conclusions

The experience and perspectives of users and non-users of the AYP platform are mostly positive, but concerns were also raised regarding patients' safety. Results suggest that AYP could be a complementary tool to offer to ambulatory patients for simple, general and non-urgent problems.

The association between Internet use and health-related outcomes in older adults and the elderly: a cross-sectional study

Background

Older adults and elderly persons can experience a significant digital divide. However, there are many studies reporting that the use of the Internet has benefits related to a person’s health status and social inclusion. It is not fully clear if Internet use and health-related outcomes share common antecedents or if using the Internet may have a favourable effect on the determinants responsible for good health. The main aim of this study was to assess the relationship between the use of the Internet and health-related outcomes in older adults and elderly people in Poland.

Methods

The effect of the use of the Internet was analysed with regression models after adjusting for sociodemographic factors. The data used for the analysis were obtained through a telephone-based survey on a representative sample of Polish adults at least 50 years of age.

Results

By categorising the frequency of Internet use by the respondents, it was found that some categories were significantly related to less favourable health behaviours. Rare Internet users were less likely to undertake physical activity than nonusers (odds ratio, OR, 95% confidence interval, 95%CI 0.48, 0.28–0.83). Those using the Internet every day less frequently consumed fruit and vegetables (OR, 95%CI 0.64, 0.42–0.99). Internet use was also associated with more frequent consumption of alcohol (OR, 95%CI 1.65, 1.09–2.50 comparing nonusers with those accessing the Internet several times a week). Persons rarely using the Internet, but not those who accessed it at least a few times a week, possessed a lower health literacy than nonusers (OR, 95%CI 0.71, 0.52–0.97). Internet users were also more likely to assess their health status as unsatisfactory (OR, 95%CI 0.59, 0.42–0.82 comparing nonusers with those using the Internet daily). Finally, the use of the Internet was consistently associated with a lower prevalence of chronic conditions and disability, as well as less frequent visits to health care facilities.

Conclusions

In conclusion, in contrast to earlier findings, Internet use is not associated with favourable patterns of lifestyle or higher self-rated health in older Polish adults. However, persons with chronic conditions or disabilities less frequently declare the use of the Internet. It was also revealed that older adults and the elderly who make use of the Internet are less likely to utilise health services.

Explaining variation in health information seeking behaviour - Insights from a multilingual survey

OBJECTIVE

How best to provide an increasingly diverse population with health information has become a major concern for health policy makers in Europe and beyond. Our study aims to investigate factors explaining variation in people's health information seeking behaviour. Our findings can be used to identify target groups for policy interventions that aim to provide health information efficiently.

METHODS

Cross-sectional, paper-based, multilingual survey of a random sample of enrolees of two statutory health insurers in Hamburg, Germany. Data were collected from September to December 2017. Multivariable logistic regression was used to examine sociodemographic and health-related individual characteristics and their associations with participants' choice of ten sources of health information.

FINDINGS

Participants' choice of information sources differed significantly across the following sociodemographic and health-related characteristics: age, gender, immigration status, education, employment status, marital status and general state of health. Immigrants and individuals with low educational attainment were most likely to use emergency departments as sources of health information.

CONCLUSION

Policy interventions aiming to manage the use of health information sources should focus on immigrants and individuals with low educational attainment. Providing multilingual, low-threshold counselling and information services could be an efficient way to reduce short-term costs of health information seeking behaviour to health insurers or other payers of care while improving patient empowerment.

A Study of eHealth from the Perspective of Social Sciences

The field of social sciences has become increasingly important in eHealth. Patients currently engage more proactively with health services. This means that eHealth is linked to many different areas of Social Sciences. The main purpose of this research is to analyze the state-of-the-art research on eHealth from the perspective of social sciences. To this end, a bibliometric analysis was conducted using the Web of Science database. The main findings show the evolution of publications, the most influential countries, the most relevant journals and papers, and the importance of the different areas of knowledge. Although there are some studies on eHealth within social sciences, most of them focus on very specific aspects and do not develop a holistic analysis. Thus, this paper contributes to academia by analyzing the state-of-the-art of research, as well as identifying the most relevant trends and proposing future lines of research such as the potential of eHealth as a professional training instrument, development of predictive models in eHealth, analysis of the eHealth technology acceptance model (TAM), efficient integration of eHealth within public systems, efficient budget management, or improvement in the quality of service for patients.

YouTube: A good source for retrograde intrarenal surgery?

Purpose

To evaluate the quality of videos for retrograde intrarenal surgery (RIRS) on YouTube (Google, LLC) from the perspective of both patients and physicians.

Materials and Methods

All videos longer than 2 minutes returned by the YouTube search engine in response to the keyword search “retrograde intrarenal surgery” were included in this study. The quality of content was analyzed by using the validated Journal of the American Medical Association Benchmark Score (JAMAS) and the Global Quality Score (GQS). Two surgeons developed the RIRS Scoring System (RIRSSS) to evaluate the technical quality of the videos. A video power index (VPI) was used to score the popularity of the videos.

Results

A total of 63 videos with a median of 389 views were included in the present study. Forty-three videos (68.3%) were provided by health care professionals and 53 videos (84.1%) included technical aspects about RIRS. The median (interquartile range) GQS, JAMAS, RIRSSS, and VPI scores were 2 (1–3), 1 (1–2), 2 (1–5), and 0.41 (0.08–1.29), respectively. Videos with audio had significantly higher GQS and RIRSSS scores than did with videos with no audio (p<0.001, p=0.039, respectively). The GQS of videos providing general information about RIRS was higher, whereas RIRSSS scores were higher for videos detailing technical aspects (p=0.027, p=0.038, respectively).

Conclusions

The quality of YouTube videos containing information about RIRS evaluated in this study was very low. It is necessary for health care organizations to prepare online materials and upload these materials to popular social media platforms to convey accurate information to patients.

Older adults’ eHealth literacy and the role libraries can play

This study examined the eHealth literacy, health knowledge, health behavior of a population of older Chinese adults, and the impact of using library or community activities for health information seeking. A survey was conducted among 215 participants 45 years or older. Data were analyzed using chi-square test, one-way analysis of variance, bivariate correlation, and multiple regression. The results showed that participants who were urban residents, non-farm workers, and had 9 years of education or more were more likely to use the library or community activities for health information seeking. Health behavior had a significant relationship with eHealth literacy and health knowledge. Both eHealth literacy and health knowledge showed a significant positive relationship with using the library or community activities for health information. These results support the idea that libraries play an important role in providing high-quality eHealth literacy services to enhance healthy behavior and health outcomes in their communities.

Access to an Electronic Health Record: A Polish National Survey

In Poland, as in many countries around the world, e-health services are becoming more and more popular. Obligatory e-sick leave was implemented, followed by e-prescriptions and e-referrals. Therefore, it is worth considering the introduction of a complete electronic health record (EHR) that can be accessed by doctors and patients. The main aim of the study is to find out whether patients want to have access to their EHRs and if they would agree to pay for such a service. The research was based on three surveys conducted among 1000 Polish adults in 2007, 2012, and 2018. The sample collection was carried out by the national opinion poll agency, with the use of computer-assisted telephone interviews. Over 60% of respondents were interested in the possibility of accessing EHRs in general, and almost 50% of them were ready to pay for it. Nevertheless, when analyzing all the year-on-year trends, they were subject to a gradual decrease. The youngest age group was the one most interested in EHRs, while the group comprising respondents in middle age was the one most willing to pay for it. There is still great potential in implementing EHRs on a bigger scale.

Development and validation of an instrument for measuring competencies on public health informatics of primary health care worker (PHIC4PHC) in Indonesia

Because of the increasing adoption and use of technology in primary health care (PHC), public health informatics competencies (PHIC) are becoming essential for public health workers. Unfortunately, no studies have measured PHIC in resource-limited setting. This paper describes the process of developing and validating Public Health Informatics Competencies for Primary Health Care (PHIC4PHC), an instrument for measuring PHC workers' competencies in public health informatics. Method: This study developed a questionnaire that had three stages: the Delphi technique, a pretest, and field test. Eleven academicians from a university and 13 PHC workers joined 2 rounds of group discussion in the first stage. The second stage comprised two pilot studies with 75 PHC workers in Semarang Municipality. The third stage involved validating the questionnaire with 462 PHC workers in Kendal District. This study used Pearson's product-moment correlation for the validity check and Cronbach's alpha coefficient for determining the internal consistency. This study used the K-means algorithm for clustering the results of the PHIC4PHC questionnaire. Results and Conclusion: PHIC4PHC is the first comprehensive PHIC questionnaire administered in a resource-limited setting, consisting of 11 indicators and 42 measurement items concerning knowledge of health information systems, skills required for health data management, ethical aspects of data sharing and health information literacy. The final results of PHIC4PHC were clustered into three classes based on the K-means algorithm. Overall, 45.7% PHC workers achieved medium competency, whereas 25.6% and 27.7% achieved low and high competency, respectively. Men had higher competency than women. The higher the worker's level of education, the higher the PHIC level; the longer the worker's work experience, the lower the PHIC score; and the greater the worker's age, the lower the PHIC score. Measuring and monitoring PHIC is vital to support successful health IT adoption in PHC.

Use of telemedicine in obstetrics and gynaecology in Zimbabwe during a lockdown period

INTRODUCTION

Telemedicine is an ideal innovation to achieve social distancing, one of the mitigating strategies during the current Covid 19 pandemic. Zimbabwe effected a 21day lockdown from the 2nd of March 2020 to control the spread of the Covid 19 infection. Free teleconsultation service was provided by the researcher. We sought to determine the effectiveness and acceptability of telemedicine in Obstetrics and Gynaecology during this period.

METHODS

We conducted a retrospective and prospective analysis of the messages from the WhatsApp consults for demographic characteristics, type and classification of condition, level of urgency, ability to make a diagnosis and the type of recommendation offered. A follow-up message was used to assess effectiveness of the medical advice given and patient satisfaction.

RESULTS

Of 109 women who used telemedicine 67consented. The average age was 31 years and most of the women were married, had university or tertiary college education and were urban dwellers. Forty-nine (73.1%) cases were Gynaecological consults and 51 (76.1%) were elective cases. Twenty (29.9%) and fourteen (20.8%) cases needed elective and urgent hospital referral respectively. A diagnosis was made in 33(49.3%) of the cases from the available information during the consult. Thirty-five (52.2%) cases had recovered whilst 27(40.3%) cases were still waiting further assessments at the end of the follow up. The patients were satisfied with the service in 94% of the cases.

CONCLUSION

Telemedicine services provided during the lockdown period were effective and acceptable in managing women with Obstetrics and Gynaecological conditions. Telemedicine should be rolled out during this pandemic to limit risk to patients and healthcare providers.

Factors affecting online health community participation behavior in patients with thyroid cancer

Globally, cancer patients obtain much of their disease information online. Online health communities allow patients to share questions and information about diseases. However, there have been few studies on the factors affecting online health community participation behavior in cancer patients. Online social networking is associated with mental health problems, and patients with thyroid cancer experience high levels of distress, anxiety and depression. The purpose of this study was to investigate factors associated with use of online health communities by patients with thyroid cancer to understand the characteristics of patients participating in such online communities. A questionnaire survey was completed by 114 thyroid cancer patients admitted for surgery at a general hospital in Seoul, Korea. General characteristics, clinical characteristics, attitude toward cancer, distress, and anxiety and depression scores of patients who joined an online health community (user group) and patients who did not (non-user group) were compared. The factors affecting online health community participation were education (p = 0.049), tumor size (p = 0.010), attitude toward cancer (p = 0.022), and anxiety and depression (p = 0.021). The average score of satisfaction with the online health community was 4.25 of 5. The user group had larger tumors, a high awareness of the risk of thyroid cancer, and high levels of anxiety and depression. Patients who actively used the online health community have relatively larger cancer size and had higher levels of mental stress. As such patients are often very anxious and depend heavily on the gathered information, the quality of this information is important. Healthcare professionals need to develop appropriate interventions for patients participating in the online health community.

Validation of a Questionnaire Developed to Evaluate a Pediatric eHealth Website for Parents

There is a need for health professionals to provide parents with not only evidence-based child health websites but also instruments to evaluate them. The main aim of this research was to develop a questionnaire for measuring users' evaluation of the usability, utility, confidence, the well-child section, and the accessibility of a Spanish pediatric eHealth website for parents. We further sought to evaluate the content validity and psychometric reliability of the instrument. A content validation study by expert review was performed, and the questionnaire was pilot tested. Psychometric analyses were used to establish scales through exploratory and confirmatory factor analyses. Reliability studies were performed using Cronbach's alpha and two split-half methods. The content validation of the questionnaire by experts was considered as excellent. The pilot web survey was completed by 516 participants. The exploratory factor analysis excluded 27 of the 41 qualitative initial items. The confirmatory factor analysis of the resultant 14-item questionnaire confirmed the five initial domains detected in the exploratory confirmatory analysis. The goodness of fit for the competing models was established through fit indices and confirmed the previously established domains. Adequate internal consistency was found for each of the subscales as well as the overall scale.

Elderly's Attitude towards the Selected Types of e-Health

This current study was sought to explore how older adults’ adaptation of information and communication technology (ICT) devices was associated with their preference for e-Health services. A total of 224 Czech older adults aged 60+ were analyzed for the study. The sample comprised 21% male and 79% female. A self-reported survey questionnaire was employed to assess the prevalence of the use of ICT devices and the Internet and general preference for e-Health services. A series of t-tests were performed between and within two groups divided into e-Health supporters and non-supporters. The results indicated that nearly half of the respondents preferred to use the Internet for searching for health-related information. We found that older adults’ use of ICT devices and educational level was significantly associated with the selection of the e-Health services. However, gender, household type, and the place for a residence did not count additional variance for the preferred e-Health services. For those who express willingness to receive the e-Health service, the preferred e-Health services should be implemented across relevant health domains. To do so, health professionals ought to provide the necessary equipment and educational programs that help older adults better access and adapt to e-Health services.

The Impact of Online Health Information on Patient Health Behaviours and Making Decisions Concerning Health

The number of Internet users searching for health-related issues increases significantly every year. The aim of this study was to investigate whether and how the information about health and disease obtained from the Internet by patients influenced them and how different e-health services can affect the patients' choice of the doctor. The research was based on a national survey conducted among 1000 Polish adults. The study was carried out with the use of the computer-assisted telephone interviews (CATI). The study showed that e-health facilities are increasingly affecting the patient's choice of doctor. Among the highest rated factors, the possibility of setting the date of appointment online and practice's own website were indicated. Information on health and disease obtained from the Internet influenced respondents in many areas. Almost half of health Internet users (HI-users) wanted to change their diet and increase healthy physical activity under the influence of health information obtained online. Regarding health decision making, health information obtained from the Internet caused 45% of HI-users to make an appointment to see a doctor, and 40% of them had questions concerning diagnosis and treatment. Information on health and disease obtained from the Internet undoubtedly affects patient behaviour and health decisions they make.

Lumbar Spine Fusion Patients' Use of an Internet Support Group: Mixed Methods Study

BACKGROUND

Internet use within health care contexts offers the possibility to provide both health information and peer support. Internet Support Groups (ISGs) for patients may offer advantages, which are not found in face-to-face support. In patients undergoing lumbar spine fusion (LSF), ISGs could have a particular potential, as peer support on the web might bridge the decreased satisfaction with social life and social isolation found within these patients. ISGs might in this way contribute to increasing the functioning and overall health-related quality of life. However, LSF patients may generally belong to a group of citizens not prone to internet and online peer support. However, our knowledge of how LSF patients use ISGs is limited.

OBJECTIVE

The aim of this study was to describe the characteristics of users of an ISG and thematically explore the content of ISG interactions in Danish patients undergoing instrumented LSF because of degenerative spine disorders.

METHODS

Participants were recruited from a randomized controlled trial and included in a prospective cohort with a mixed methods design. Sociodemographic characteristics and information on psychological well-being (symptoms of anxiety and depression) were obtained at baseline and 1 to 5 weeks before surgery. Usage of the ISG was registered from baseline until 3 months after surgery. All posts and comments were collected, and content analysis was performed.

RESULTS

A total of 48 participants comprised the study population, with a mean age of 53 years (range 29-77). Of the participants, 54% (26/48) were female, 85% (41/48) were cohabitating, 69% (33/48) were unemployed, and the majority (69% [33/48]) had secondary education. Approximately one-third of the participants had symptoms of depression (35%, 17/48) and anxiety (29%, 14/48). Overall, 90% (43/48) of the participants accessed the ISG. No correlations were found between sociodemographic characteristics and access to the ISG. Women were more prone to be active users, contributing with posts (P=.04). Finally, active users contributing with posts or comments had viewed more pages, whereas passive users, users without posts or comments, had more interactions with the ISG (P<.001). The ISG contained 180 conversation threads, generating 354 comments. The 180 conversation threads in the ISG were constituted by 671 independent dialogue sequences. On the basis of those 671 dialogue sequences, 7 thematic categories emerged.

CONCLUSIONS

Sociodemographic characteristics were not predictors of ISG use in this study, and active use was found to be gender dependent. Content of interactions on the ISG emerged within 7 thematic categories and focused on social recognition, experience of pain or use of pain medication, experience of physical activity or physical rehabilitation, expression of psychosocial well-being, advising on and exploring the ISG, and employment, which seemed to correspond well with the prevalent occurrence of symptoms of anxiety and depression.

Inequalities in the Use of eHealth Between Socioeconomic Groups Among Patients With Type 1 and Type 2 Diabetes: Cross-Sectional Study

BACKGROUND

The prevalence of diabetes and the use of electronic health (eHealth) are increasing. People with diabetes need frequent monitoring and follow-up of health parameters, and eHealth services can be highly valuable. However, little is known about the use of eHealth in different socioeconomic groups among people with diabetes.

OBJECTIVE

The aim of this study was to investigate the use of 4 different eHealth platforms (apps, search engines, video services, and social media sites) and the association with socioeconomic status (SES) among people diagnosed with type 1 and type 2 diabetes mellitus (T1D and T2D, respectively).

METHODS

We used email survey data from 1250 members of the Norwegian Diabetes Association (aged 18-89 years), collected in 2018. Eligible for analyses were the 1063 respondents having T1D (n=523) and T2D (n=545). 5 respondents reported having both diabetes types and thus entered into both groups. Using descriptive statistics, we estimated the use of the different types of eHealth. By logistic regressions, we studied the associations between the use of these types of eHealth and SES (education and household income), adjusted for gender, age, and self-rated health.

RESULTS

We found that 87.0% (447/514) of people with T1D and 77.7% (421/542) of people with T2D had used 1 or more forms of eHealth sometimes or often during the previous year. The proportion of people using search engines was the largest in both diagnostic groups, followed by apps, social media, and video services. We found a strong association between a high level of education and the use of search engines, whereas there were no educational differences for the use of apps, social media, or video services. In both diagnostic groups, high income was associated with the use of apps. In people with T1D, lower income was associated with the use of video services.

CONCLUSIONS

This paper indicates a digital divide among people with diabetes in Norway, with consequences that may contribute to sustaining and shaping inequalities in health outcomes. The strong relationship between higher education and the use of search engines, along with the finding that the use of apps, social media, and video services was not associated with education, indicates that adequate communication strategies for audiences with varying education levels should be a focus in future efforts to reduce inequalities in health outcomes.

Use of Electronic Health and Its Impact on Doctor-Visiting Decisions Among People With Diabetes: Cross-Sectional Study

Background

Despite the increasing prevalence of diabetes and increasing use of electronic health (eHealth) among people with diabetes, little is known about the association between the use of eHealth and the use of provider-based health services.

Objective

The objective of this study was to investigate whether the use of eHealth might change patients’ decisions regarding doctor-seeking behavior and whether information acquired from the internet was discussed with a doctor.

Methods

We used email survey data collected in 2018 from members of the Norwegian Diabetes Association (aged 18 to 89 years) diagnosed with diabetes. Using logistic regressions, we studied patients’ internet-triggered changes in decisions regarding doctor visits; whether they discussed information from the internet with a doctor; and whether these topics were associated with gender, age, education, self-rated health, and self-reported anxiety/depression.

Results

Among the 895 informants, 75.4% (645/856) had never made an internet-triggered change of decision in any direction regarding visiting a doctor, whereas 16.4% (41/859) had decided to visit and 17.3% (148/856) had decided not to visit. The probability of changing decisions decreased with higher age and increased with the severity of self-reported anxiety/depression. Around half of the study participants (448/858, 52.2%) had never discussed information from the internet with a doctor. The probability of discussing internet information with a doctor was higher for those in bad/very bad self-rated health (odds ratio 2.12, CI 1.15-3.90) and for those with moderate self-reported anxiety/depression (odds ratio 2.30, CI 1.30-4.10).

Conclusions

Our findings suggest that using eHealth has a significant impact on doctor-visiting decisions among people with diabetes, especially among people aged 18 to 39 years and among those reporting anxiety/depression. It is of great importance that the information posted is of high quality and that the large differences between internet-users regarding age as well as mental and somatic health status are taken into account. More research is needed to confirm and further explore the findings of this study.

Digital Information Technology Use and Patient Preferences for Internet-Based Health Education Modalities: Cross-Sectional Survey Study of Middle-Aged and Older Adults With Chronic Health Conditions

Background

Health information, patient education, and self-management (health information and advice, HIA) tools are increasingly being made available to adults with chronic health conditions through internet-based health and mobile health (mHealth) digital information technologies. However, there is limited information about patient preferences for using specific types of health information and advice resources and how preferences and usage differ by age group and education.

Objective

The objective of this study was to examine how use of digital information technologies and preferred methods for obtaining health information and advice varies by age group and education among middle-aged and older adults with chronic health conditions.

Methods

The study used cross-sectional survey data for 9005 Kaiser Permanente Northern California members aged 45 to 85 years who responded to a mailed and Web-based health survey conducted during 2014 and 2015 and indicated having at least 1 chronic health condition. Bivariate analyses and logistic regression models with weighted data were used to estimate and compare the prevalence of digital information technology use, past-year use of internet-based health information and advice resources, and preferences for using internet-based, mHealth, and traditional health information and advice modalities for adults aged 45 to 65 years, 66 to 75 years, and 76 to 85 years.

Results

The percentages of adults who used digital information technologies (computers, smartphones, internet, email, and apps), had obtained health information and advice from an internet-based resource in the past year, and who were interested in using internet-based and mHealth modalities for obtaining health information and advice declined with age. Within age group, prevalence of digital information technologies use and interest in internet-based and mHealth modalities was lower among adults with no college education versus college graduates. Differences in preferences for internet-based health information and advice modalities between the oldest and younger groups and those with lower versus higher education were substantially diminished when we restricted analyses to internet users.

Conclusions

Health care providers and organizations serving middle-aged and older adults with chronic health conditions should not assume that patients, especially those who are older and less educated, want to engage with internet-based and mHealth resources. In addition, increasing the engagement of nonutilizers of digital devices and the internet with internet-based health information and advice and mHealth apps might require both instrumental (eg, providing digital information technology devices, internet, and skills training) and social support. As part of patient-centered care, it is important for providers to ascertain their patients’ use of digital information technologies and preferences for obtaining health information and patient education rather than routinely referring them to internet-based resources. It is also important for health care providers and consumer health organizations to user test their Web-based resources to make sure they are easy for older and less educated adults to use and to make sure that it remains easy for adults with chronic conditions to obtain health information and patient education using offline resources.

Associations Between the Use of eHealth and Out-of-Hours Services in People With Type 1 Diabetes: Cross-Sectional Study

BACKGROUND

Despite the increasing prevalence of diabetes and the increasing use of eHealth, little is known about the association between provider-based health services and eHealth among people with diabetes. This is the second study in a project exploring the associations between the use of eHealth and the use of provider-based health services.

OBJECTIVE

The objective of this study was to investigate which eHealth services are used among out-of-hours (OOH) visitors with type 1 diabetes (T1D), and whether the use of eHealth (eg, apps, search engines, video services, and social media) was associated with the use of OOH services. We also wanted to investigate associations between anxiety, reassurance, and change in doctor-seeking behavior because of health information acquired from the Internet, and the use of OOH services.

METHODS

We used data from a 2018 email survey of members of the Norwegian Diabetes Association (18-89 years old). Respondents with T1D were eligible for analyses. Using descriptive statistics, we estimated the use of OOH services and eHealth. Using logistic regressions, we studied the associations between the use of OOH services and the use of eHealth, as well as associations between the use of OOH services and reported consequences of using Internet-based health information.

RESULTS

In the sample of 523 people with T1D (mean age 47 years), 26.7% (129/484) visited OOH services once or more during the previous year. Among the OOH visitors, search engines were used for health purposes by 86.7% (111/128), apps (health apps in general) by 63.6% (82/129), social media by 45.3% (58/128), and video services by 28.4% (36/127). The use of OOH services was positively associated with self-reported anxiety/depression (odds ratio [OR] 4.53, 95% CI 1.43-14.32) and with the use of apps (OR 1.73, 95% CI 1.05-2.85), but not with other types of eHealth. Those who had felt anxious based on information from the Internet were more likely to visit OOH services compared with those who had not felt anxious (OR 2.38, 95% CI 1.50-3.78). People who had decided to consult a doctor based on information from the Internet were more likely to visit OOH services (OR 2.76, 95% CI 1.64-4.66), compared to those who had not made such an Internet-based decision.

CONCLUSIONS

People with T1D were frequent users of OOH services, and the OOH visitors were frequent users of eHealth. The use of OOH services was positively associated with the use of health apps, with self-reported anxiety/depression, and with feeling anxious based on information from the Internet. Likewise, deciding to consult a doctor based on information from the Internet was positively associated with OOH visits. The use of eHealth seems to have a significant impact on people with T1D.

Internet use and eHealth literacy among health-care professionals in a resource limited setting: a cross-sectional survey

BACKGROUND

Health-care professionals should be able to identify and use reputable health care-information sources from the Internet and other relevant sources of information, in order to make good medical decisions. The level in health professional eHealth literacy and the extent of Internet use in a resource-constrained setting is not well documented. The aim of this study was to assess the extent of Internet use and eHealth literacy among a cross section of health-care professionals at the University of Gondar Comprehensive Specialized Hospital, northwest Ethiopia.

METHODS

An institution-based cross-sectional study was conducted to assess Internet use and eHealth literacy among health professionals working at the hospital from November 20 to January 17, 2018. Descriptive analysis was used to describe Internet use and eHealth literacy. Multivariable logistic regression was done to identify which factors were associated with the eHealth literacy of participants.

RESULTS

In total, 291 study subjects were approached and included in the study, with a response rate of 98.6%. The majority of respondents were female (53.7%) and the mean age was 30.09±5.025 years. Only 47.4% of survey respondents said that they used the Internet regularly for professional/medical updates. The mean eHealth literacy was 27.840±5.691. The majority of participants with high eHealth literacy were aged 21-29 years. and females were slightly more literate regarding eHealth than males (33.1%). Age, type of profession, salary, and years of experience were significantly associated with eHealth literacy.

CONCLUSION

The present data confirm that Internet use and eHealth literacy of health professionals is noticeably good, which clearly suggests that there is an opportunity for eHealth to be integrated in the health-care system in tertiary-health facilities in northern Ethiopia if appropriate training and education is provided.

The Internet as a Source of Health Information and Services

The Internet is increasingly used for health-related purposes and evolves with the ever-changing needs of patients. The aim of this study was to assess the level of reliance on the Internet as a health information source, to examine which online communication activities are the most common for health purposes, and to determine the attitudes and needs of patients in this area and the factors affecting its use. A total of 1000 adults were selected from the Polish population by random sampling. The survey was administered by the Computer-Assisted Telephone Interview (CATI). The study concluded that 76.9% of the participants used the Internet for health purposes, among whom 72.6% of active and 27.4% of passive users were distinguished. The role of the Internet as a source of health information has increased, which corresponds to a growing interest in online health services. The majority of individuals searching for health information in the Internet lived in urban areas, had a high level of education, and was professionally active. We conclude that the increased interest in the use of the Internet related to health determines the direction in which e-health should be developed in the future.

Online Health Technologies and Mobile Devices: Attitudes, Needs, and Future

Advances in mobile technology constitute a promising and evolving trend that enables better access to health care especially for the elderly, disabled, and chronically ill. It overcomes geographical, temporal, and organizational barriers at low and affordable costs. The aim of the study was to evaluate the needs and expectations of Polish citizens and their attitudes toward mobile health (mHealth) services using mobile phones and communication devices in medical care and also to evaluate the sociodemographic factors affecting such behavioral processes. A total of 1000 adults were selected from the Polish population by random sampling. The assessment was made with the use of computer-assisted telephone interview (CATI). Approximately 78% of the study participants were proficient mobile phone users with a predominance of young people. Forty-seven percent of them expressed the desire to obtain information about their health via their mobile phone if they had the opportunity to do so. Important factors associated with the aforementioned statement included younger age, being still in education, or unemployed. Among the mHealth supporters, the vast majority of people (84%) would like to receive SMS (short message service) reminders for appointments and prescribed medicines. Other favorable mHealth activities were e-registration (77.9%), viewing test results online (80.6%), or receiving basic medical recommendations (75.7%). Only 30% of the respondents had a positive attitude toward teleconsultation, while 17.8% of them were willing to pay for this option. Further research on emerging new and beneficial mHealth solutions needs to be conducted.

Design and validity of a questionnaire to assess national eHealth architecture (NEHA): a study protocol

INTRODUCTION

eHealth is critically important to build strong health systems, and accelerate the achievement of sustainable development goals, particularly universal health coverage. To support and strengthen the health system, the eHealth architecture needs to be formulated and established prior to the implementation and development of any national eHealth applications and services. The aim of this study is to design and validate a standard questionnaire to assess the current status of national eHealth architecture (NEHA) components.

METHODS AND ANALYSIS

This study will use a mixed-methods design consisting of four phases: (1) item generation through review of evidences and experts' opinions, (2) face and content validity of the questionnaire, (3) determination of a range of possible scenarios for each item included in the questionnaire and (4) evaluation of reliability. This questionnaire is expected to generate critical and important information about the status of NEHA components that will be useful for monitoring, formulating, developing, implementing and evaluating NEHA. Our paper will contribute, we envisage, to establishment of a socio-technical basis on which governments and other relevant sectors can compare the policy interventions that boost the availability and utilisation of eHealth services within their settings.

ETHICS AND DISSEMINATION

The Ethics Committee for Research at the Tehran University of Medical Sciences approved the study protocol. We will obtain informed consent from each participant and collect data anonymously to maintain confidentiality. The translation of the findings into future policy planning will include the production of a series of peer-reviewed articles, presentation of the findings at relevant eHealth conferences and preparation of policy reports to the international organisations aiming to strengthen national capacity for better-informed eHealth architecture.

Pediatric Web-Based Chat Services for Caregivers of Children: Descriptive Study

Background

Pediatric physician-led Web-based chat services offer a novel, low-threshold communication channel between caregivers and physicians.

Objective

Our aim was to describe chat conversations between caregivers and physicians in a Web-based chat service to determine the factors that should be considered when planning a similar chat service. We also aimed to evaluate whether caregivers considered the consultations helpful, whether physicians considered they could answer caregivers’ questions, and whether further face-to-face medical contact was needed.

Methods

In September 2015, a private medical center for children in the greater Helsinki area initiated a Web-based chat service, accessible via any device with an internet connection, open from 9 am to 9 pm local time. Four residents in pediatrics, who had performed at least 60% of their 6-year residency program, served as the physicians responsible for chat consultations with caregivers of children. Between October 2015 and March 2016, 343 consecutive consultations were immediately evaluated by a chat physician. On average, caregivers were followed up by email questionnaire 7-14 days later, which 98 caregivers answered a median of 11 (interquartile range, IQR, 7-20) days later.

Results

The age of the children whose caregivers contacted the chat service was a median of 2.1 (IQR 0.83-4.69) years, and 29.8% (102/342) of the children were less than 1 year old. The majority (119/343, 34.7%) of the chat conversations took place from 9 am to noon, and infections were the most common concern in over half of cases (189/343, 55.1%). Chat physicians recommended a face-to-face appointment with a physician for that same day in 13.7% (47/343) of the cases. A face-to-face exam was recommended for that same day more often if the chat concerned infection (36/189, 19.0% cases) compared with other reasons (11/154, 7.1%, cases; P=.001). Physicians felt capable of answering caregivers’ questions in 72.6% (249/343) of the cases, whereas 93% (91/98) of caregivers considered physicians’ answers helpful. Whether caregivers had to take their children to see a physician that same day or whether caregivers’ main concern was infection was not found to be associated with whether caregivers considered physicians’ answers helpful or not. However, physicians felt more capable of answering caregivers’ questions when the main concern was infection.

Conclusions

Parental consultations via Web-based chat service often take place before noon and focus on infection-related issues as well as on the health and illness of very young children. These factors should be considered when planning or setting up such a service. Based on the high satisfaction with the chat service by both physicians and caregivers, Web-based chat services may be a useful way to help caregivers with concerns about their child’s health or illness.